administrator from the relevant agency to appear at the next scheduled hearing. By holding all
members of the child’s team accountable for the well-being of the commercially sexually
exploited child, the team will develop more efficient ways of delivering services.
F. Medical Advocacy
GALs routinely monitor a child’s physical health as part and parcel of their duties.91 The
federal Fostering Connections to Success and Increasing Adoptions Act92 requires localities to
“detail the steps that are or will be taken to ensure the continuity of health care services, including
the possibility of establishing a medical home for every child in care and what will be done to
ensure the oversight of prescription medications, including psychotropic drugs.”93 GALs should
act to ensure that the client is linked to a consistent and quality health care provider. “Whenever
a change in placement is needed, they should try to keep the child in the same geographic area
and make sure all the professionals involved in the case understand the importance of maintaining
the child’s medical home.”94
For a CSEC client, GALs should request particularized sexual-health education and
advocate for comprehensive physical health screenings, including HIV prophylaxis if appropriate,
after each and every abscondence. In this way, the CSEC-informed GAL continually educates
and reminds the court and parties that each runaway episode should not be treated routinely or
likened to non-CSEC runaway experiences.
Furthermore, the GAL should ensure that the client has access to safe and consistent
methods of contraception. If there are periods where a female client is incarcerated or
hospitalized, these may be opportune moments to ensure that the client meets with a physician
and accesses appropriate long-term contraception (such as the Depo-Provera shot,95 or an intrauterine device), if she so desires.
Finally, the GAL should monitor whether the client is eligible for and enrolled in
appropriate health insurance programs, such as Medicaid. Pursuant to the federal Patient
Protection and Affordable Care Act of 201096, states must “offer youth who exited foster care
extended Medicaid coverage to up to their 26th birthday if the youth was in care on their 18th
birthday (or older).”97
G. Placement and Family Assessment
GALs maintain a global view of the case, and are thus uniquely positioned to make
placement recommendations that integrate a child’s various mental health, medical, social and
educational needs. GALs may be called upon by the court to make recommendations about what
type of placement is in a child’s best interest, whether family location and reunification is
appropriate, and what additional services (housing, therapeutic intervention, etc.) may facilitate
GALs should visit their client’s living environment to better understand the strengths and
weaknesses of the child’s home life.98 GALs are trained to conduct these types of custodial
91 ABA STANDARDS, supra note 47 (RULES C-2(1), C-4(5), H-3, K-2).
92 Fostering Connections to Success and Increasing Adoptions Act of 2008, Pub. L. No.110-351, 122 Stat. 3949.
93 Eva J. Klain, Addressing the Health Needs of Court-Involved Youth (Mar. 15, 2011),
95 Depo-Provera is a hormonal contraceptive birth control shot that is given once every three months. Depo-Provera (contraceptive
injection), MAYO CLINIC, http://www.mayoclinic.org/tests-procedures/depo-provera/basics/definition/prc-20013801 (last visited Apr.
96 Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010).
97 See Klain, supra note 93.